Healthcare Provider Details

I. General information

NPI: 1659464675
Provider Name (Legal Business Name): LONG BEACH VA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/02/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 THE CITY DR S
ORANGE CA
92868-3201
US

IV. Provider business mailing address

60 CORNFLOWER
IRVINE CA
92620-3389
US

V. Phone/Fax

Practice location:
  • Phone: 714-456-5853
  • Fax:
Mailing address:
  • Phone: 714-390-0985
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License NumberA82484
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code282N00000X
TaxonomyGeneral Acute Care Hospital
License NumberA82484
License Number StateCA

VIII. Authorized Official

Name: AMIR MASOUD KARAM
Title or Position: STAFF SURGEON
Credential: MD
Phone: 565-826-8000